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Excessive daytime napping linked with elevated risk of heart rhythm disorder

Stroke Prevention
Pathophysiology and Mechanisms
Epidemiology, Prognosis, Outcome
Risk Factors and Prevention
Diagnostic Methods

Malaga, Spain – 13 April 2023:  Daytime napping for 30 minutes or longer is associated with an increased likelihood of developing atrial fibrillation, according to research presented at ESC Preventive Cardiology 2023, a scientific congress of the European Society of Cardiology (ESC).1

“Our study indicates that snoozes during the day should be limited to less than 30 minutes,” said study author Dr. Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain. “People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”

Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 People with this arrhythmia have a five times greater risk of stroke than their peers. Dr. Diaz-Gutierrez said: “Previous studies have suggested that sleep patterns may play a role in the development of atrial fibrillation, but as far as we know this was the first study to analyse the relationship between daytime napping and risk of the arrhythmia.”

The study used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates. A total of 20,348 participants free of atrial fibrillation at baseline completed a questionnaire every two years. Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.

Participants were divided into three groups according to their average daily napping duration at baseline: none, less than 30 minutes, and 30 minutes or more. Short daytime nappers were defined as those who snoozed for less than 30 minutes.

New atrial fibrillation diagnoses were initially self-reported and subsequently confirmed by an expert committee of cardiologists, who used a predefined protocol which included reviewing medical records. The risk of atrial fibrillation according to daytime napping duration was analysed after adjusting for the information collected in the questionnaire.

The average age of participants at baseline was 38 years and 61% were women. During a median follow up of 13.8 years, 131 participants developed atrial fibrillation. Compared to short daytime nappers, those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26–2.86). Meanwhile, compared with short nappers, risk was not elevated in those who avoided napping (HR 1.26; 95% CI 0.82–1.93).

The researchers conducted a second analysis to identify the nap duration associated with the lowest risk of atrial fibrillation. This analysis included those who reported regular napping and excluded participants who did not nap. Participants were divided into three categories according to their average daily napping duration at baseline: less than 15 minutes, 15 to 30 minutes, and more than 30 minutes. Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 minutes had a 42% lower risk of developing atrial fibrillation (HR 0.58; 95% CI 0.35–0.95) while those who napped for 15 to 30 minutes had a 56% reduced risk (HR 0.44; 95% CI 0.27–0.72).

Dr. Diaz-Gutierrez said: “The results suggest that the optimal napping duration is 15 to 30 minutes. Larger studies are needed to determine whether a short nap is preferable to not napping at all. There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress.”



1The abstract ‘Daytime napping and the risk of atrial fibrillation in the SUN cohort’ will be presented during the session ‘Moderated ePoster 5’ which takes place on 13 April at 17:30 CEST at Moderated ePoster Station 2.
2Hindricks G, Potpara T, Nikolaos Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498.

Notes to editor

Authors: ESC Press Office 
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Funding: The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III and the European Regional Development Fund (FEDER), the Navarra Regional Government, Plan Nacional Sobre Drogas, the University of Navarra, and the European Research Council.

Disclosures: The authors declare no potential conflicts of interest.

About the European Association of Preventive CardiologyThe European Association of Preventive Cardiology (EAPC) is a branch of the ESC. Its mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.

About ESC Preventive Cardiology          #ESCPrev2023
ESC Preventive Cardiology, formerly EuroPrevent, is the leading international congress on preventive cardiology and the annual congress of the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC).

About the European Society of CardiologyThe European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

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